title: Clinical evaluation of peripartum outcomes of mediolateral versus lateral episiotomy.
abstract: OBJECTIVE
  To evaluate the incidence and extent of vaginal and perineal trauma among primiparous women after mediolateral and lateral episiotomy.
  
  
  METHODS
  In a prospective randomized study at University Hospital Pilsen, Czech Republic, 790 consecutive primiparous women were enrolled between April 2010 and April 2012. Mediolateral episiotomy (MLE) followed an angle of at least 60° from the midline. Lateral episiotomy (LE) started 1-2 cm laterally from the midline and was directed toward the ischial tuberosity. A rectal examination was performed before episiotomy repair.
  
  
  RESULTS
  MLE was performed for 390 women, and LE for 400. The groups did not differ in maternal or neonatal characteristics. No difference was found in incidence or extent of vaginal and perineal trauma; or in additional perineal (1.8% vs 1.5%, P=0.6) or vaginal (8.5% vs 10.6%, P=0.2) trauma continuing along the episiotomy incision. The incidence of anal sphincter injury did not differ between MLE and LE (1.5% vs 1.3%, P=0.7). MLE was associated with shorter repair times (P<0.05), less suturing material (P<0.05), and shorter distances from the anus (P<0.001).
  
  
  CONCLUSIONS
  Risk of additional vaginal and perineal trauma, and anal sphincter injury after adequately performed mediolateral episiotomy is relatively low and corresponds to that of lateral episiotomy.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Jaroslava
authors.initials: J
authors.lastname: Karbanova
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Rusavy
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Lucie
authors.initials: L
authors.lastname: Betincova
authors.affiliation: European Centre of Excellence NTIS - New Technologies for Information Society, Faculty of Applied Sciences, University of West Bohemia, Czech Republic.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Jansova
authors.affiliation: Department of Gynecology and Obstetrics, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Antonin
authors.initials: A
authors.lastname: Parizek
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital, Faculty of Medicine, Charles University, Pilsen, Czech Republic. Electronic address: kalisv@fnplzen.cz.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kalis
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000293:injuries; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D004841:Episiotomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D061646:Operative Time; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D014621:Vagina / Q000293:injuries; D055815:Young Adult
keywords: Blood loss; Lateral episiotomy; Mediolateral episiotomy; Obstetric anal sphincter injuries; Perineal trauma; Vaginal trauma